Staging and grading of stomach cancer

The stage describes how far the cancer has grown from where it started, and whether it has spread anywhere else. And grading is about how cancer cells look under a microscope when compared with normal cells.

The stage describes how far the cancer has grown from where it started, and whether it has spread anywhere else.

Knowing the stage is important. It affects the decisions you and your doctors make about the treatment| you have.

It’s only possible to tell the exact stage of the cancer after an operation to remove it.

There are two main ways that stomach cancer is staged: the TNM system and the number system.

TNM staging system

The most commonly used staging system for stomach cancer is the TNM staging system.

T refers to the size and spread of the tumour. This will be a number between 0 and 4 depending on the size and spread of the tumour.

N refers to whether nearby lymph nodes have cancer cells in them. This will be a number between 0 and 3 depending on how many lymph nodes contain cancer cells.

M refers to whether the cancer has spread to other parts of the body (secondary or metastatic cancer). The M stage will be 0 if it hasn’t spread and 1 if it has.

As an example, a cancer may be described as T3 N2 M0.

Number staging system

This describes the stage of stomach cancer with a number ranging from 1 to 4.

Stage 1

The cancer is only in the lining of the stomach (mucosa) and may have spread to 1–2 lymph nodes.

OR

The cancer has grown into the muscle layer of the stomach but there is no cancer in the lymph nodes.

Stage 2

The cancer is in the stomach lining (mucosa) and has spread to 3 or more lymph nodes.

OR

The cancer has grown into the muscle layer and has spread into 1–6 lymph nodes.

OR

The cancer has reached the outer stomach layer (serosa) but is only in 1–2 lymph nodes. OR The cancer has grown through the stomach wall but hasn’t grown into nearby tissues or spread to the lymph nodes.

Doctors sometimes call stages 1 and 2 early stomach cancer.

Stage 3

The cancer has grown into the muscle layer and has spread into 7 or more lymph nodes.

OR

The cancer has reached the outer stomach layer (serosa) and has spread into 3 or more lymph nodes.

OR

The cancer has grown through the stomach wall. It has also spread into lymph nodes and/or into nearby tissues such as the liver, gullet or abdominal wall.

Doctors call stage 3 locally advanced stomach cancer.

Stage 4

The cancer has spread outside the stomach to other parts of the body, such as the lungs or bones.

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